Anaesthesia for emergency caesarean section, 2000-2004, at the Royal Women's Hospital, Melbourne.

The provision of anaesthesia for emergency caesarean section is a major part of the workload of obstetric anaesthetists and the urgency often dictates the mode of anaesthesia that can be provided. We have audited the provision of anaesthesia for 'immediate' caesarean sections over a four-year period following the introduction of a 'Code Green' system to coordinate a rapid response to an obstetric decision to proceed with an 'immediate' caesarean section. The records of all patients for whom a Code Green was called between July 2000 and June 2004 were studied. The reasons for the call, interval timings (for example decision-to-delivery interval) and type of anaesthesia used were collected. There were 444 Code Green procedures, of which 47 were excluded due to incomplete data. The most common indication was fetal distress' and the three most common types of anaesthesia used were general (n = 206), Epidural top-up (n = 106) and spinal (n = 65). Mean decision-to-delivery intervals (+/- SD) for all caesarean sections were 17 (+/- 6) minutes with general anaesthesia, 19 (+/- 9) minutes with epidural and 26 (+/- 9) minutes with spinal anaesthesia. Forty-five percent of calls were made between the hours of 0700 and 1700 h. General anaesthesia was most used between the hours of 0700 and 1700 h. A swift response to the call for an immediate caesarean section can be achieved when suitable facilities and procedures are in place. Administering an epidural bolus into an already established epidural catheter that is working effectively can allow a decision-to-delivery interval almost as short as general anaesthesia.